Today’s resource is outstanding for ALL LEARNERS who are taking the Pediatric Advanced Life Support course (PALS).
Drs Stoner and Patel, among the many great pearls, emphasize the importance of being ready to suction the airway, especially in cases of massive hemoptysis.
In Emergency Medicine Cases‘ Ep 188 [Adult] Hemoptysis – ED Approach and Management the speakers recommend attaching a meconium aspirator to suction in massive hemoptysis as massive hemoptysis can overwhelm even multiple Yankauer suction devices. My only experience with the meconium aspirator is in the Neonatal Resuscitation Course (NRC).
I have reached out to the authors of today’s resource to ask them if the meconium aspirator attached to suctioning would be safe and appropriate for use in newborns, infants, toddlers, and children with massive hemoptysis
Today’s resource is outstanding for ALL LEARNERS who are taking the Pediatric Advanced Life Support course (PALS).
Today, I reviewed, link to, and reviewed the show notes of PedsCrit‘s* Intubation Essentials with Dr. Alyssa Stoner and Dr. Gina Patel, Part 1 Preparation and Checklists
JULY 01, 2021 PEDSCRIT
*This PedsCrit link is to a complete list of all the topics covered on this wonderful site. At the time of this post, there are 78 pediatric critical care topics covered.
All that follows is from today’s resource.
About our guests:
Dr. Alyssa Stoner is an Assistant Professor of Pediatrics, University of Missouri-Kansas City School of Medicine and practicing pediatric intensivist at Children’s Mercy Kansas City.
Dr. Gina Patel is a fellow in pediatric critical care at Children’s Mercy Kansas City.How to support PedsCrit?
Please share, like, rate and review on Apple Podcasts or Spotify!
Donations appreciated @PedsCrit on Venmo –100% of all funds will go to supporting the show to keep this project going.Objectives
- The participant will be able to compile a complete list of equipment necessary to perform a pediatric intubation, with acknowledgment of mnemonic.
- The participant will be able to determine the appropriate size and depth of insertion of endotracheal tube based on patient’s age utilizing a common estimation formulas.
- The participant will be able to describe the appropriate patient set up; including positioning for a successful intubation.
When a checklist is elusive a simple mnemonic can be helpful to recall the necessary equipment:
Mnemonic: SOAP ME
Suction Device: Ensure suction is turned on and at appropriate level
- Yaunker or large bore suction tube 14 French
- Consider second suction set up especially if concerned about pulmonary hemorrhage or pulmonary edema
Oxygen Delivery system: ensure oxygen sources is connected and functioning appropriately
- Nasal Cannula vs. High Flow/ Non-Rebreather
- Consider non-Invasive if poor oxygenation
- Consider need for apneic oxygenation depending on clinical situation
- Self-inflating anesthesia bag with appropriately sized mask
Airway Equipment:
- Direct Laryngoscope: Blade type and size considerations
- Video Laryngoscope: CMAC or Glidescope dependent upon access and comfort
- Endotracheal tube: Correct size + size down
- Back up airway IE: Laryngeal Mask Airway (LMA)
Patient Position: Most of procedural success is based upon the appropriate patient positioning
- Consider age of patient and position accordingly to achieve appropriate sniffing position, consider utilizing small shoulder roll (in patients <2years of age) or a small pillow for adolescents/adult sized patients to align all three axis (Oral axis, laryngeal axis and pharyngeal axis) to allow for best view
Medication plan: specific to patient and clinical scenario, there are many combinations that can be utilized and some for specific scenarios.
- Analgesic agent: ie: Fentanyl
- Amnestic agent: ie: Versed
- Paralytic agent: ie: Rocuronium
Equipment: ensure all monitors placed appropriately (BP cuff and pulse ox on separate extremities)
- BP monitoring (art line or non-invasive)
- Pulse ox
- Telemetry leads
- Capnography/End tidal (attached to monitor/ventilator, calorimetry)
- Ventilator
